Cross-cultural validation of the educational needs assessment tool into Chinese for use in severe knee osteoarthritis

Figures & data

Table 1 Patient characteristics (N=196)

Characteristics	Mean±SD or number (%)
Age (years)	63.1±8.7
Sex, female	112 (57.1)
Disease duration (years)	11.5
Educationa
Low	47 (24.0)
Medium	117 (59.7)
High	32 (16.3)
PEPPI (range, 0–100)	74.98±20.1
SEE (range, 0–90)	62.11±18.4
SER (range, 0–120)	90.34±23.4
ENAT (range, 0–156)	88.69±29.1

Notes:

a Low = none, primary school, lower-level vocational training, lower-level secondary general education; medium = middle-level vocational training, higher-level secondary general education; high = higher-level vocational training, academic certification.

Abbreviations: ENAT, educational needs assessment tool; PEPPI, perceived efficacy in patient–physician interactions; SEE, self-efficacy for exercise scale; SER, self-efficacy for rehabilitation.

Figure 1 The process of cross-cultural adaptation of the ENAT into Chinese.

Abbreviations: BT1, back-translation 1; BT2, back-translation 2; ENAT, educational needs assessment tool.

Figure 2 Standardized factor loading and residuals for the items of the Chinese version of educational needs assessment tool.

Table 2 Factor analysis of the CENAT rotating element matrixa

Item	Factor
	1	2	3	4	5
Pain1	0.343	0.242	0.101	0.225	0.742
Pain2	0.369	0.094	0.195	0.634	0.267
Pain3	0.144	0.286	0.138	0.789	−0.010
Pain4	0.155	0.236	0.281	0.766	0.029
Pain5	0.030	0.213	0.110	0.751	0.205
Pain6	0.155	0.010	0.222	0.668	0.348
Movement7	0.374	0.412	0.390	0.234	0.275
Movement8	0.166	0.275	0.424	0.189	0.477
Movement9	0.182	0.516	0.227	0.225	0.441
Movement10	0.469	0.254	0.226	0.389	0.346
Movement11	0.305	0.724	0.180	0.282	0.089
Feeling12	0.184	0.322	0.587	0.399	0.223
Feeling13	0.398	0.168	0.614	0.435	−0.019
Feeling14	0.416	0.016	0.191	0.363	0.434
Feeling15	0.336	0.071	0.601	0.413	0.135
Disease16	0.187	0.505	0.199	0.188	0.582
Disease17	0.463	0.446	0.377	0.249	0.255
Disease18	0.284	0.562	0.391	0.233	0.078
Disease19	0.526	0.581	0.131	0.225	0.150
Disease20	0.373	0.328	0.331	0.258	0.315
Disease21	0.377	0.454	0.241	0.341	0.174
Disease22	0.533	0.505	0.091	0.084	0.257
Treatment23	0.452	0.264	0.346	0.126	0.628
Treatment24	0.681	0.296	0.359	0.169	0.219
Treatment25	0.650	0.399	0.144	0.091	0.259
Treatment26	0.662	0.259	0.377	0.219	0.113
Treatment27	0.668	0.245	0.332	0.134	0.257
Treatment28	0.609	0.478	0.148	0.131	0.333
Treatment29	0.624	0.127	0.311	0.447	0.092
Selfhelp30	0.211	0.311	0.675	0.247	0.331
Selfhelp31	0.340	0.318	0.513	0.316	0.209
Selfhelp32	0.213	0.603	0.377	0.097	0.266
Selfhelp33	0.337	0.668	0.216	0.246	0.206
Selfhelp34	0.279	0.741	0.212	0.118	0.215
Selfhelp35	0.651	0.512	0.193	0.139	0.007
Support36	0.272	0.333	0.673	0.155	0.269
Support37	0.664	0.240	0.289	0.229	0.224
Support38	0.307	0.517	0.554	0.112	0.080
Support39	0.685	0.343	0.136	0.118	0.269

Notes: Extraction method: principal component. Rotation method: orthogonal rotation method with Kaiser standardization.

a Rotation converges after the eighth iteration.

Abbreviation: CENAT, Chinese version of the educational needs assessment tool.

Table 3 Spearman’s correlations between the CENAT and other measures

CENAT	ENAT	PEPPI	SER	SEE	Disease duration	Age
CENAT
Spearman’s correlations	1	0.40**	0.40**	0.39**	−0.11	−0.03
P		0.000	0.000	0.000	0.114	0.690
N	196	196	196	196	196	196
Bootstrapa
Deviation	0	−0.003	−0.002	−0.000	0.005	0.000
Standard error	0	0.069	0.067	0.069	0.067	0.074
95% CI
Floor	1	0.251	0.264	0.249	−0.239	−0.178
Ceiling	1	0.426	0.514	0.521	0.025	0.111

Notes:

a Unless otherwise noted, bootstrap results are based on 1,000 bootstrap samples.

** p<0.01.

Abbreviations: CENAT, Chinese version of ENAT; ENAT, educational needs assessment tool; PEPPI, perceived efficacy in patient–physician interactions; SEE, self-efficacy for exercise scale; SER, self-efficacy for rehabilitation.

Table S1 Back-translation, issues, and agreements for each educational needs assessment tool item

Original	Back-translation 1 (BT1)	Back-translation 2 (BT2)	Issues	Agreement
Arthritis educational needs assessment tool	Assessment tool for educational needs in patients with arthritis	The tool for assessing needs for education in patients with arthritis related	Chinese language has multiple meanings for the word “arthritis”	关节炎教育需求评估工具 “Arthritis” is the most adequate translation
How long have you had your arthritis for?	How long have you been diagnosed with arthritis?	How long have you suffered from arthritis?	Uncertainty whether word “diagnosed” or “suffer” should be used in the Chinese version	“您因为关节炎病了多久?” The Chinese translation is correct in terms of style
Please state your age in years:	Please state your age	Please state your age in years:	Discussion on whether phrase “in years” is needed.	“请陈述您的年龄” The phrase “in years” has been omitted
How old were you when you left school?	How old were you when you graduated from school?	How old were you when you graduated from school	Education in the Chinese system does not require age information	“您的学历是” The most appropriate Chinese phrase was chosen
At this time, do you want education about anything to help you deal with your arthritis?	Do you want to get information which will help you manage arthritis?	Do you want to help yourself to cope with arthritis by any obtaining education?	Uncertainty how to translate into Chinese “manage” or “cope with”	“您希望获得应对自身关 节炎的信息吗” Chinese translation is correct in terms of style
If yes, what?	If yes, what information would you like to get?	If yes, what would you like to know?	Uncertainty how to translate into Chinese “get” or “know”	“如果是，您想知道什么” Chinese version is correct in terms of style
In general, how much information do you want about your arthritis?	In general, how much would you like to know about your arthritis?	In general, how much information would you like to get about your arthritis?	Discussion on whether word “information” should be added	“通常，您想了解多少关 于关节炎的知识?” The word “information” was added
How much do you need to know now about each of the following things? Please tick in the column that shows best how you feel:	How much do you need to know now about each of the following issues? Please tick in the column that shows best how you feel:	How much would you already know about the following issues? Please mark the appropriate column with an “√”	Discussion concerning the phrase “Please mark the appropriate column with n ‘√’”	“下列问题您想了解多少？请在适当的列表下 打勾” Chinese version is correct in terms of style
Using heat or cold on painful joints	Treatment of painful joint by cold or heat	Reduce the pain of joints by cold or heat	Uncertainty how to translate into Chinese “treatment” or “reduce”	“用冷热疗法处理关节疼痛” The most correct Chinese phrase has been chosen
This section relates to managing pain	Section on managing pain	Section on dealing with pain	Discussion on whether to choose a more formal way of introducing section of questions	“疼痛管理相关部分” A more formal way of introducing a new section was chosen
How important is it for you to know more about the following	How important is it for you to know more about the following issues for you?	How important is it for you would know more about the following issues?	Discussion on a formal way of asking a question	“知道以下更多的信息对 您来说有多重要” A formal way of asking a question has been chosen
Using exercise	Physical exercise	Functional exercise	Uncertainty whether “physical” and “functional” can be used synonymic	“运动疗法” The most correct Chinese phrase was chosen
The section relates to movement	Section on issues related to movement	Section on issues related to mobility	Discussion on word choice between “movement” and “mobility”	“活动相关部分” The most adequate Chinese version was chosen
Ways of doing things which wear my joints less	Methods of reducing wear of joints	Ways of relieving joints	“Wear my joints less” was repeated in the Chinese phrase	“缓解关节磨损的方法”
Ways to deal with moods or depression	Ways to alleviate moods or depressive states	Ways to cope with moods or depressive states	Discussion on word choice between “alleviate” and “cope with”. Ambiguous meaning of the term “moods”	“应对负性情绪或抑郁状态的方法” The chosen term “negative emotion” means frequent changes in mood
Why I am feeling down or depressed	Why do I feel moody or depressed	Why do I feel disappointed or depressed?	Ambiguous meaning of the phrase “feeling down”	“为什么我会感到情绪低落或沮丧?” The chosen term “moody” relates to feel down
What type of arthritis do I have	What type of arthritis do I have	What type of arthritis do I have	Lack of knowledge of arthritis in Chinese patients	“我患有哪种关节炎?” Chinese version is correct in terms of style
How might arthritis t affect my children or relatives	What is the effect of the disease on my children and family?	Can the disease affect the lives of my children and family?	Multiple meaning of word “affect”	“关节炎对我的孩子和家人会产生什么影响” The chosen phrase “the effect of” relates to “affect”
Ways my arthritis can be treated	Therapies for arthritis	The treatment of arthritis	Uncertain whether to use the word “therapies” or “treatment” in the Chinese version	“关节炎治疗方法” The most adequate Chinese translation was chosen
Ways my arthritis is affecting me	Ways arthritis is affecting me	The way of my arthritis is affecting me	Multiple meaning of word “affect”	“关节炎对我造成影响的方式?” The chosen phrase “the effect of” relates to “affect”
What might happen in the future	What will happen to me in the future	How will my condition change in the future	The question is open ended	“在未来，我的状态将如何改变” The translation focuses on patient’s condition in the future
This section is about treatments you may be receiving from health professionals.	Section on treatments that you can receive from medical professionals.	Section contains treatments that the patient can receive from nurses and other health professionals	Lack of a Chinese equivalent of a term “health professionals”	“你能得到健康护理工作者治疗的部分” The chosen phrase describes the meaning of “health professionals”
How operation might help me	Can surgery help me	Can surgery help me	Uncertainty how to translate “operation” into Chinese	“手术能帮助我吗” The most adequate Chinese term was chosen
What are the side effects of my medicines	What are the side effects of my drugs	Are there any side effects to the drugs		“药物的副作用是什么” Chinese version is correct in terms of style
How aid might help me (splints, adaptations, collars)	What aid may help me (orthopedics orthotics, splints, fixators)	What aids can help me (orthopedics orthotics, splints, fixators)	Difficulty with translating term “adaptations” and “collars”	“器具怎么可以帮助我”（骨科矫形器、夹板、固定器） Descriptive phrases “adaptations” and “collars” have been chosen
Alternative treatments or herbal remedies	Conservative treatment or Chinese traditional treatment	Conservative treatment or Chinese traditional treatment	Multiple meanings of the phrase “alternative treatments” and “herbal remedies”	“保守治疗或中医疗法” The most adequate Chinese term has been chosen
Foods or vitamins that might help	Diet or vitamins that may help	Foods or vitamins which might help	More formal version of question in Chinese should be given	“食物或维生素能带来的帮助” Chinese version is correct in terms of style
Exercises I should be doing	Recommended exercises	Recommended exercises	Uncertainty whether the word “recommended” should be used	“推荐的运动” The most adequate Chinese translation was chosen
How much exercise should I be doing	Amount of exercise	Amount of exercise	Uncertainty whether the word “amount” should be used	“运动量” The most adequate Chinese term was chosen
Times when I should call the doctor or nurse	Times when I should contact a doctor	Situations when I should consult a doctor	Uncertainty whether the word “situations” is adequate, and lack of a Chinese equivalent of the sentence “Registered nursing don’t provide consultative services regarding issues relevant to the practice of nursing for outpatients”	“在什么情况下，我应该看医生?” Chinese translation is correct in terms of style
Organizations I can get in touch with about arthritis	Departments which can help patients with arthritis	Departments that can help patients with arthritis	Lack of a Chinese equivalent of a term “Arthritis Organizations”. Uncertainty whether “departments” is the correct translation of the term “organizations”	“哪些部门可以帮助关节炎患者” Chinese phrase describing contacting an organist was chosen
Who I can ask for financial help	Who can I ask for financial help	Who can I ask for financial help	Lack of cultural equivalence (it is possible to ask for financial help in case of suffering from arthritis)	“我可以向哪里寻求经济帮助?” Chinese version is correct in terms of style
Where I can find groups who will help me to cope with arthritis	Where can I find support groups for arthritis	Where can I find support groups for people with arthritis	Lack of cultural equivalence (it is possible to ask for help outside the health care system)	“我在哪里可以得到病友的帮助?”
How I can get the most out of seeing the doctor or nurse	How to make more effective contacts with the doctor or nurse	How can I improve communication with the doctor or nurse to maximize effectiveness	Idiomatic meaning of the “get the most out of” can be translated in various ways in Chinese	“如何提高与医生或护士的交流效果” Chinese version is correct in terms of grammar

Note: Arthritis Educational Needs Assessment Tool, ©2013, The University of Leeds; All rights reserved.